Knee
Sutter Orthopaedic Institute

It wasn't very many years ago that patients with knee problems simply had to live with pain and limited movement or undergo open surgery and lengthy recoveries. Rapid advancements such as less invasive arthroscopic surgery have provided tremendous benefits to patients of all ages. Advancements continue to move rapidly ahead as the population ages and demand for knee repair grows.

Diagnosis

The knee is a complex joint designed to provide maximum support (see structures of the knee). Because of its complexity and constant use, several types of damage can occur. An orthopedic surgeon must first determine the type and severity of the damage before determining the best course of treatment. Testing may include blood tests to locate any underlying health conditions and joint fluid analysis to assess the state of the fluid that cushions the knee. Diagnostic imaging tests are also generally performed and may include traditional X-ray, arthrogram (joint X-ray), magnetic resonance imaging (MRI), ultrasound, or CT scan. Once the surgeon has determined the exact nature of the problem, patients receive the surgeon's recommendations for the best course of care.

Treatment

Sutter orthopedic surgeons offer a host of treatments aimed at providing children and adults greater motion and less pain through the least invasive methods. Information about diagnosis and treatment of many knee conditions is available in our Health Information Library under the following topics: Anterior Cruciate Ligament (ACL) Injuries; Anterior Knee Pain; Arthritis (Osteoarthritis); Arthritis, Rheumatoid; Bursitis; Knee Problems and Injuries; Knee Replacement Surgery; Kneecap Instability; Kneecap Tracking Disorder; Meniscus Tear; Patellar Tracking Disorder; Patellofemoral Pain Syndrome; Tendinitis; Tendinopathy; and Tendinosis.

Additional information resources include the American Academy of Orthopaedic Surgeons, National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) and Save Your Knees.

Recent Advances

Medical science has evolved in the past several years to expand the surgeon's treatment options. Many Sutter orthopedic specialists offer patients the opportunity to take advantage of these advances.

Cartilage Restoration and Repair

One of the most promising areas of treatment is articular cartilage repair or restoration. Sutter orthopedic surgeons offer several of these newer treatments including:

• Abrasion arthroplasty – The surgeons uses arthroscopic tools to locate the damaged knee cartilage and scrape off the hard bone tissue to stimulate the body's healing response. As the abrasion heals, fibrocartilage (similar to scar tissue) fills in the previously missing cartilage.
• Microfracture surgery – Using arthroscopic tools, the surgeon creates small openings in the bone surface behind the damaged cartilage to allow blood to flow into the area and build new fibrocartilage.
• Cartilage transfer (osteochondrial autograft transfer or OAT) – The surgeon removes small sections of healthy bone and cartilage from a non-weight-bearing area of the knee and places it into the damaged area. A similar technique called osteochondrial allograft uses bone and cartilage from a cadaver.
• Cartilage (autologous chondrocyte) implantation (Carticel) – The surgeon uses arthroscopic tools to remove healthy cartilage cells from the patient's knee, which are sent to a laboratory and placed in a biologic solution that encourages them to multiply. Several weeks later, the surgeon places the newly grown cartilage cells into the patient's knee and covers it with tissue to hold the new cartilage in place until it attaches.
• Synovial fluid replacement – Joints contain a lubricating fluid called synovial fluid that helps protect the joints from impact. When injuries or repetitive use cause synovial fluid to break down, less cushioning occurs. Surgeons can inject hyaluronic acid, one of the components in synovial fluid, into the knee joint to restore proper cushioning.

Total Knee Replacement

When the bones and cartilage of the knee show significant damage, surgeons replace the joint with an artificial joint made of metal or ceramics. Knee replacement surgeries are performed through traditional and minimally invasive techniques at all Sutter hospitals, with Sutter orthopedic surgeons providing more initial and revision hip and knee replacement surgeries than any other provider in the region.

Meniscus Repair and Reconstruction

At the edge of the articular cartilage lie softer cartilage cushions called the menisci. When the meniscus wears away or tears (see meniscus tear), pain can develop. Sutter surgeons offer arthroscopic treatment to repair damaged meniscus tissue. Some surgeons also offer new treatments to repair or replace more seriously damaged meniscus tissue, including meniscus reconstruction or transplants from a cadaver (allograft).

Tendon and Ligament Repair and Reconstruction

Many knee conditions are caused by damage to the ligaments (see structures of the knee), often resulting from sports-related injuries. Mild tears may heal without treatment, while more serious damage requires surgical repair. Sutter orthopedic surgeons provide arthroscopic surgery to correct ligament tears, including using grafts from the patient, an artificial implant, or from a cadaver.

Ask Your Surgeon

While there are a number of treatment options now available for knee conditions, Sutter surgeons can offer insight into the various treatment options based on the patient's specific knee condition.

In addition to current treatments, several Sutter orthopedic surgeons are actively involved in clinical trials through Sutter Institute for Medical Research, providing patients access to the latest advances in knee treatments. Patients interested in volunteering to participate in a clinical trial should discuss opportunities with their surgeons.

Find Out More

Patients generally receive referrals from their primary care doctors to an orthopedic surgeon. To self-refer or learn more about surgeons who care for knee conditions, go to the Physician Directory and select Orthopedic Surgery from the drop-down menu under Physician Specialties. Clicking on a physician's name opens a profile, which offers more insight into the physician's areas of concentration.